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Its the little things too – moral courage

It’s been a week and a half since the Francis report was published and there is much media attention on whistle blowing and having the courage to say when things are not right. I always worry; I’m a ‘worrit’- a northern expression for someone who consistently worries, in this instance I worry that I might not be up to the mark – would I actually have the courage to whistle blow? The answer is – I don’t know but I hope so.

The media of the past week has made me reflective and think about how I might respond if I was in the position to see something that wasn’t right and it took me back to 1987 when I was a second year student nurse. In those days we always did a 6 week rotation into psychiatry as part of our general training.

The hospital we spent this time at was an old fashioned hospital that had originally been a workhouse. Looking back I think the accommodation was poor for good care. It was dark, stark and formal. There was little in the way of homeliness for anyone. There was a charge nurse on the ward who I was afraid of; he was austere and unapproachable and I avoided him where I could. The ward was full of very unwell people and we had a patient called Fred, who was so severely depressed he was catatonic. I remember observing him having ECT but more than that I recall how we had to encourage him to eat and remind him to go to the toilet. He was a very poorly man.

One day I was on duty and I was shocked and horrified to see Fred in the loo, with his trousers around his ankles and the Charge Nurse trying to force feed him a drink supplement by holding his nose and forcing it into his mouth, with his head tipped back. I went straight to the nursing officer and reported what I had seen. I don’t remember much of what happened after that. I know that I never saw the Charge Nurse on the ward again. I remember writing down what I had seen. I don’t remember much more – although I can still see, in my head, Fred on the loo, being force fed.

My memory of this was only stirred up this week and I took courage and strength from what I remembered. I think I must have just gone straight to the senior nurse and reported what I had seen with no hesitation and no fear – because I knew I was doing the right thing.
But having moral courage isn’t always about big decisions – it’s about the small things too. It’s about knowing what is right and speaking up when that doesn’t happen. I know that sometimes that it difficult to do but I believe that is what nursing is about. Cultures are about people and behaviours and if we fail to speak out when things are not right we are colluding and are ourselves part of the problem. So, we need both the leadership skills to create effective cultures but also to take responsibility for individual actions.

In a paper called ‘Moral Distress and Moral Courage in Everyday Nursing Practice’ (Gallagher 2010) it discusses the concept of moral professional courage. It is seen as part of everyday practice, and as I say, not only the big things but the little things that confront us every day in professional working life. Gallagher also makes it clear that while the culture and organisational climate are important for us to be able to practice moral courage it is also an individual responsibility. It’s an article that is worth a read!

I took strength from my memory and hope I will be strong enough to have moral courage wherever I am and not just for big things – but for small everyday things too.

Me in York around the time of being a second year student. I look very young!

8 thoughts on “Its the little things too – moral courage”

A great reminder of the importance of knowing what’s the right thing, as well as the wrong. An ethical core helps with moral courage; courage itself is underrated, so I am pleased to see it as one of the 6Cs and exemplified here by Annie.

Its the small stuff which we can do starting with gently feedback on things which are wrong .. a sharp word … a patient being ignored… rather than turning a blind eye each of us must deal with our personal discomfort and with kindness offer feedback on what we have observed and ask what we personally can do to help. Great thoughts Anne

This is a great post Annie, and I agree with every word. I think individuals can influence so much, even when they don’t realise it. Positive feedback, questioning negative comments of their peers etc. Many HCPs blame ‘the management’ when they are part of the culture too. Love your blog…still need to comment on another post. Hope you are well Sheena x

Thanks so much for this Annie – a really timely and sobering reminder. It can be really hard to do the right thing, the moral thing, if you fear that your career or your reputation may be at stake. And yes, you do look great in that uniform!

Excellent piece. Absolutely agree, if we don’t speak out, we are complicit. However, it’s not easy, and when I did so, as a post-reg student in 1989, I was made to feel that I was doing something wrong. Nevertheless I never regretted my actions, although I know I would have regretted a failure to act.